NPIMap

Individual provider Active NPI

Benjamin W Dickey, MD, MPH

  • Family Medicine Physician
  • Santa Rosa, CA
National Provider Identifier
1932526860
Registry record updated Oct 21, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
A149307 Issued in CA
Practice address
2323 Bethards Dr
Santa Rosa, CA 95405-8500
Phone
(707) 542-1611
Fax
(707) 542-9958
NPI assigned
Mar 28, 2014
Last updated
Oct 21, 2021By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 21, 2021

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X
Family Medicine Physician 207Q00000X A149307 CA Primary

Addresses

Primary practice location

2323 Bethards Dr
Santa Rosa, CA 95405-8500

Mailing address

2323 Bethards Dr
Santa Rosa, CA 95405-8500

Other practice location 1

210 NW Barstow St
Waukesha, WI 53188-3771
Phone (262) 548-6903

Other names 1

  • Benjamin Dickey Former name

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address bdickey1657644@oc.providencedirect.org

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20170627001172 CA Practitioner - Family Practice 4183923469 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 2014
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Providence Medical FoundationGroup PAC ID 8921993205, 1,461 clinicians

Practice addresses (Care Compare)

2323 Bethards Dr
Santa Rosa, CA 95405-8500
Phone (707) 542-1611

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions35
Removal or shaving of skin growth1-10
Skin biopsy1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
149307CAMDMarriage & Family Therapist
A149307CAMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Providence Medical Foundation Current Accepting new patients
Providence Medical Foundation CurrentSince Jul 3, 2017 Accepting new patients
Providence Medical Foundation Family Medicine CurrentSince Jul 3, 2017 Accepting new patients
St. Joseph Health Northern California, LLC Past Accepting new patients
Prohealth Waukesha Memorial Hospital, Inc. Past Accepting new patients
Providence Medical Foundation Family Medicine Past Accepting new patients

Locations

200 W Ctr St Promenade
Ste 400
Anaheim, CA 92805

1165 Montgomery Dr
#1112
Santa Rosa, CA 95405
Phone (707) 546-3210

2323 Bethards Dr
Santa Rosa, CA 95405
Phone (707) 542-1611

500 Doyle Park Dr
Ste 100
Santa Rosa, CA 95405
Phone (714) 449-4842

Interoperability endpoints

  • Direct secure messaging: bdickey1657644@oc.providencedirect.org

Organizations & group practices 6

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 5

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1395964800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1634774400000",
    "number": "1932526860",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2323 BETHARDS DR",
            "city": "SANTA ROSA",
            "state": "CA",
            "postal_code": "954058500",
            "fax_number": "714-937-6233"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2323 BETHARDS DR",
            "city": "SANTA ROSA",
            "state": "CA",
            "postal_code": "954058500",
            "telephone_number": "707-542-1611",
            "fax_number": "707-542-9958"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "210 NW Barstow St",
            "address_purpose": "LOCATION",
            "city": "Waukesha",
            "state": "WI",
            "postal_code": "531883771",
            "country_code": "US",
            "telephone_number": "262-548-6903",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "DICKEY",
        "first_name": "BENJAMIN",
        "middle_name": "W",
        "credential": "MD, MPH",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2014-03-28",
        "last_updated": "2021-10-21",
        "certification_date": "2021-10-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "CA",
            "license": "A149307",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "bdickey1657644@oc.providencedirect.org",
            "affiliation": "N",
            "address_1": "2323 Bethards Dr",
            "city": "Santa Rosa",
            "state": "CA",
            "country_code": "US",
            "postal_code": "954058500",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "BENJAMIN",
            "last_name": "DICKEY",
            "credential": "MD",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Santa Rosa, CA

Sources for this page

Verify at the official NPI Registry.